African Americans with a family history of colorectal cancer were no more likely to follow screening guidelines compared with those without a family history of the disease, according to a recent article in Cancer (2008;113:276–285).
Kathleen Griffith, PhD, CRNP, of Johns Hopkins University, and colleagues from the University of Maryland at Baltimore analyzed data from the 2002 Maryland Cancer Survey, an anonymous telephone survey of 5,040 Maryland residents.
Of the 580 African Americans eligible for this study (based on age and completeness of responses), 88 had a family history of the disease (at least 1 first-degree relative with colorectal cancer). The study population was comprised primarily of women (65%), and the majority of respondents were aged 50 to 65 years. Most had health insurance (88.8%) and had attended and/or graduated college (48%). Among participants, 47% were employed, and 41% were retired.
African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. Although colorectal cancer screening rates have improved over the last few years, the percentage of African Americans being screened is still significantly lower than the overall US average.
To help understand why many African Americans are not getting screened, the researchers studied Maryland Cancer Survey data regarding family history, screening history, body mass index, education, insurance status, physician recommendations for screening, and lifestyle behaviors.
“A big challenge to understanding what influences this population is that we don't have a lot of good data. This is one of few studies to look at a large group of African Americans who are at increased risk,” says Durado Brooks, MD, MPH, American Cancer Society Director of Prostate and Colorectal Cancer.
The strongest predictors of screening among African Americans without a family history of the disease (n = 492) were whether their doctor had recommended fecal occult blood testing (odds ratio [OR], 11.90; 95% confidence interval [CI], 6.84 to 20.71), whether their doctor had recommended sigmoidoscopy or colonoscopy (OR, 7.06; 95% CI, 4.11 to 12.14), whether they engaged in moderate to vigorous physical activity (OR, 1.74; 95% CI, 1.06 to 2.28), and whether they had a prostate-specific antigen screening history (OR, 2.68; 95% CI, 1.01 to 7.81). Among African Americans with a family history (n = 88), those with a physician recommendation for sigmoidoscopy or colonoscopy (OR, 24.3; 95% CI, 5.30 to 111.34) and those who engaged in vigorous physical activity (OR, 5.21; 95% CI, 1.09 to 24.88) were more likely to be screened.
Having a family history of colorectal cancer did not predict whether an individual was more likely to get screened, after controlling for age, education, and insurance status, even though perceived risk of cancer was much higher among African Americans with a family history than those without (40% compared with 15% considered themselves to be at high risk).
“These observations raise some questions,” says Brooks. “Why isn't this population getting screened? How strongly are physicians endorsing screening messages? Are there beliefs at work in this group that impede screening efforts?”
Several other studies have also shown that when doctors do recommend screening, it has an impact.
“Provider recommendation had by far the strongest influence on screening rates,” says lead researcher Kathleen Griffith. “All providers need to be aware of screening guidelines.”
For physicians who are looking for ways to incorporate discussions about screening guidelines into their practices, Brooks recommends the resources at http://www.cancer.org/colonmd.
“This study reinforces the fact that as of 2002 [the year of this survey], communications between primary care physicians and African Americans on this issue were poor,” says Brooks. “Hopefully, if this study were repeated today, we'd see that more people were getting screened. There is still much work that needs to be done.”